Claims and Risk Management

Workers' Compensation

We assist state employees who have been injured on the job and ensure excellent customer service throughout the process.

Have you been injured on the job?

The Workers’ Compensation Program assists injured state and higher government employees in the recovery process, provides access to exceptional medical services and providers, and ensures excellent customer service during the entire workers’ compensation process.

The Division contracts with a third-party administrator for the processing of state employees’ workers’ compensation claims through a managed-care framework that includes a provider network and pharmacy management. The Division’s staff monitors the work done by the administrator and acts as a liaison between state employees, the third party administrator, and medical providers.

medical interview with patient

Managed-care services provide:

24/7 Nurse triage

Pre-certification for impatient hospital care

Large case management

Bill review

Other services to appropriately manage the costs

What do you do if you're involved in an incident on the job?

Following these steps will ensure a successful claims process.

Step 1: Immediately notify your supervisor

When notifying your supervisor, be sure to do the following:

Explain how it happened.
Name any witnesses.
Tell your supervisor if you were injured as a result of the incident.

If you witness a work-related incident where a fellow employee is injured and cannot notify his/her supervisor, you should notify the supervisor for them.

man on phone with supervisor

Step 2: Call the 24/7 nurse triage line to report an injury

Call the center with your supervisor present at 1-866-245-8588, option #1, immediately after the incident occurs.

nurse with clipboard on phone

You will consult with a registered nurse to determine options

When on the phone with the call center, you will speak to a registered nurse to evaluate the nature of your injury and determine immediate care or treatment options. Your supervisor will need to be on the line to verify that the injury is work-related.

medical center

You may be directed to a medical provider

The registered nurse will then document the call and enter the incident report into the CareMC reporting system. If there is no injury, no other action must be taken by you and your supervisor. If you have been injured, the nurse may direct you to the nearest State-approved medical provider for treatment. In this case, your supervisor is responsible for completing the claim process.

doctor reviewing information with patient

You must choose an authorized provider

You must choose a provider who is authorized in the State workers' compensation network. This will be the only physician authorized to treat you for your compensable injury. The State will not pay any medical expenses you incur from a physician other than your treating physician or a network physician you are referred to by your treating physician.

doctor reviewing on tablet with patient

Follow-up appointments must be arranged by a Workers' Compensation adjuster

The Division of Claims and Risk Management utilizes a third-party administrator to assist with processing claims. Follow-up doctor and/or specialist appointments must be arranged by the adjuster and NOT by the injured employee or the employee’s supervisor. NOTE - This does not apply in situations requiring immediate emergency room treatment for serious or life-threatening injuries.

emergency room

Emergency room visits may involve different follow-up procedures

If you are seen in an emergency room or a minor medical clinic and you were told to see a specialist or your “regular/normal” physician for follow-up care, you must call the Human Resources Department prior to any follow up treatment. Human Resources will call your claims examiner for a panel of three. The panel will be given to Human Resources, and you will need to go to Human Resources to sign the panel form. All doctors must be on the State’s approved physicians list prior to follow-up treatment.

man on phone with supervisor

Step 3: Complete the reporting process

If treatment is sought, complete the reporting process (with your supervisor still present) by asking the registered nurse to transfer the call to the First Notice of Loss Unit after the registered nurse has entered their notes.

You may also call the First Notice of Loss Unit directly at (866) 245-8588, option #2.

If your supervisor is unable to answer the questions asked on this phone call, your supervisor must notify their Human Resources Department prior to the end of their shift.

Human Resources option to report

Human Resources personnel may also call 1-866-245-8588, option #2, or they may complete the First Notice of Loss online via CareMC. If the employee and supervisor did not call the registered nurse, and the incident was reported to Human Resources and was non-medical, the Human Resources personnel may enter the incident directly into CareMC.

human resources

Things to remember when filing a claim

Following these steps will ensure a successful claims process.

Notify the doctor's office of injury and claim

When seeking medical treatment, notify the doctor’s office that you were injured while at work and that you will be filing a claim for workers’ compensation benefits through the State.

Fill prescriptions under Workers' Compensation, NOT the State Insurance

Follow the instructions of the third party administrator relative to your pharmacy benefits. Do not fill prescriptions to be billed to your general health insurance carrier.

Do NOT present your health care card for medical treatment

DO NOT present your health care card for medical treatment, or while filling a prescription. Your health insurance and workers’ compensation coverage are two separate plans that do not overlap.

Do NOT request drug tests from the workers' compensation medical provider

Workers’ compensation does not require nor pay for drug testing, however, if your employer requires a drug test for your position, DO NOT request from the workers’ comp medical provider. All drug tests must be performed by National Toxicology Specialists (NTS). Only drug tests from NTS are acceptable.

Keep your supervisor and/or HR Department notified daily

It is your responsibility to keep your supervisor and/or Human Resources Department notified on a daily basis regarding your work status while out of work on workers’ compensation. Explain what medical care is being prescribed and your current condition and give them copies of all the paperwork issued by the treating physician stating when you can return to work, if follow-up visits are requested, and the need for physical therapy (if applicable). This written documentation must be forwarded to Human Resources. Due to HIPPAA compliance, ONLY the Human Resources Department will store the medical records related to an employee’s injury on the job.

A case manager may be assigned

The State of Tennessee and the State’s TPA reserve the right to review certain claims for compensability and may assign a case manager to assist an employee. Certain outpatient procedures must be pre-certified by state processes before occurring. Providers of these services know they should contact the adjuster before diagnostic testing, physical therapy, injections, surgeries, referrals, etc.

File a workers' compensation claim

Call the Workplace Injury & First Notice of Loss Call Center at 866-845-2588, and select Option 2

Reporting fraud involving state employees’ workers’ compensation claims

If you feel a state employee has fraudulently filed a workers’ compensation claim, you may report the fraud online at comptroller.tn.gov, or by calling the Comptroller of the Treasury’s hotline at 1-800-232-5454. Instructions for reporting online: